Individual
KELSEA MICHELLE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1070
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11293178-1206
UT
Other
Enumeration date
11/27/2018
Last updated
03/14/2023
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